Alaska

2018 MIDTERM ELECTION

I should note up front that despite the snarky headline, this is actually good news on the whole, and Premera does deserve some credit for it since part of the $250 million they refer to below is voluntary on their part.

Premera Blue Cross, the sole carrier offering ACA exchange individual market policies throughout the entire state of Alaska, and one of the major carriers on the indy market in Washington State, posted this press release today:

Premera Announces $250 Million Investment In Customers and Community

Mountlake Terrace, Wash. — (March 12, 2018) — Premera Blue Cross, a leading health plan in the Pacific Northwest, today announced $250 million in investments over five years across Washington and Alaska to help stabilize the individual market, improve access to care in rural areas and support local communities in their efforts to address the behavioral health issues impacting their residents.

A couple of weeks ago, a joint letter was sent to all four Congressional leaders from AHIP (America's Health Insurance Plans), the BlueCross BlueShield Association, the American Academy of Family Physicians, the AMA, the American Hospital Association and the Federation of American Hospitalsm warning them, in no uncertain terms, of what the consequences of repealing the individual mandate would be:

We join together to urge Congress to maintain the individual mandate. There will be serious consequences if Congress simply repeals the mandate while leaving the insurance reforms in place: millions more will be uninsured or face higher premiums, challenging their ability to access the care they need. Let’s work together on solutions that deliver the access, care, and coverage that the American people deserve.

As part of their Godawful "tax reform" bill, Congressional Republicans have decided to toss repealing of the ACA's individual mandate penalty into the mix, partly because they've always hated it but mainly because doing so would allegedly save the federal government $338 billion over the next decade...which in theory would be enough to keep the total increase in the federal deficit bythe tax bill below the $1.5 TRILLION mark (yes, you read that correctly: $1.5 TRILLION, with a "T").

Back in August, I reported that thanks to their just-approved federal reinsurance program, Alaska (which has only a single individual market carrier with the most expensive premiums in the country) is looking at an impressive 22% average decrease in their indy market premiums next year. However, that was based on the assumption that CSR reimbursement payments would not be made (or at least not guaranteed).

Alaska (along with Hawaii) will continue to receive Obamacare’s premium tax credits while they are repealed for all other states. It appears this exemption will not affect Alaska receiving its state allotment under the new block grant in addition to the premium tax credits.

Delays implementation of the Medicaid per capita caps for Alaska and Hawaii for years in which the policy would reduce their funding below what they would have received in 2020 plus CPI-M [Consumer Price Index for Medical Care].

Provides for an increased federal Medicaid matching rate (FMAP) for both Alaska and Hawaii."

Well, now.

Bird doesn't have the actual legislative text, but they threw Hawaii in there as well (not to win their votes...Dems Brian Schatz and Mazie Hirono are solid NOs no matter what). That means that the wording is probably along the lines of:

Alabama, Alaska and Wyoming only have a single insurance carrier participating in each of their individual markets. While this is a bad thing from a competitiveness POV, it cetainly makes things easier for me from a tracking-average-rate-hikes POV.

ALSO IMPORTANT: The HHS Dept. is also starting to upload the rate filings to the official RateReview.Healthcare.Gov database, which should make things easier for me going forward (assuming that the data is uploaded properly and isn't messed with, which is a distinct possibility when it comes to the Trump Administration)

You may have noticed that among my 16 recommendations for repairing/improving the ACA, I foolishly failed to include one of the most important/obvious ones: Reinsurance. I didn't include it for two reasons: Partly because, quite frankly, I simply forgot about it and feel bad about myself now.

So far, two states (Alaska and Minnesota) have already established their own state-based reinsurance programs; in both cases, it was done as an act of sheer desperation...and, in both cases were put through in a bipartisan fashion (both states have GOP-held legislatures, but Minnesota's Governor is Democratic while Alaska's is Independent):

There was a time, just a few months ago, when it looked like Alaska, which had already suffered from massive rate hikes the past 2 years due to their unique healthcare situation, might have a complete catastrophe on their hands with a third year of massive individual market rate hikes.

There was a time, just a few months ago, when it looked like Alaska, which had already suffered from massive rate hikes the past 2 years due to their unique healthcare situation, might have a complete catastrophe on their hands with a third year of massive individual market rate hikes.

Fortunately (and to their credit), the GOP state legislature worked with the Independent governor to pass a new law which created a state-based reinsurance program to stave off the ugly hikes. In July, it looked as though this would result in not-fantastic-but-not-awful 10% average increase:

A major health insurer is seeking an average rate increase of about 10 percent on individual health insurance policies in Alaska, far less than what it received the last two years. Thisfollows recent steps by the state to shore up Alaska's insurance marketplace.

Premera Blue Cross Blue Shield is expected to be the only company offering individual health policies in Alaska in 2017, with Moda Health planning to leave that market. Premera received average rate increases of nearly 40 percent for 2015 and 2016.

Every year, Republicans insist that the ACA is guaranteed to cause a rate hike "death spiral" as increasing premiums cause healthier people to drop out of the individual exchange market, causing higher medical expenses, causing even higher premiums, causing more healthy people to drop out and so forth...and every year, for three years in a row so far, this has failed to be the case nationally. While premiums have obviously continued to increase for many people, the individual insurance market has grown each year, from around 11 million in 2013 to 15.6 million in 2014, around 17 million last year and up to 19-20 million or so today.

Back in January I noted that Moda Health Plans, which had plenty of self-inflicted wounds in addition to being kneecapped by the Risk Corridor Massacre, was dropping out of the Oregon exchange and likely the Alaska exchange as well, so today's news isn't a big surprise.

The individual market in Alaska has just two carriers in 2016: Moda and Premera. Both have struggled with significant losses under the ACA, and Moda nearly exited the Alaska market altogether in late January (more details below).

Remember how the Risk Corridor program was put in place specifically to help guide insurance carriers through the rocky, turbulent, confusing waters of the early years of the ACA exchanges by mitigating massive premium rate miscalculations the first few by having carriers which did better than expected chip into a kitty to be passed out to those which missed the target for the first 3 years?

Remember how the carriers which lost money the first year were really, really counting on those Risk Corridor funds to be there to help cushion the blow?

Until this year, most of the ACA exchanges, including HealthCare.Gov, would simply report how many people selected QHPs through the exchange, whether paid up or not. There's nothing wrong with this as long as it's made clear at some point how many people actually paid their premiums and had their policies effectuated; the argument over this issue was the entire basis of the infamous "But how many have PAID???" fuss back in 2014. It was such a Big Deal that the Republicans on the House Energy & Commerce Committee even published the results on a laughably garbage-filled "survey" they had sent out to a portion of the insurance carriers.

One other small Medicaid expansion entry: Alaska, which just formally launched the expansion program on September 1st, has enrolled about 7,700 residents to date. While that's a pretty tiny number, Alaska only has about 740,000 residents total, of which only 42,000 are even eligible for ACA expansion anyway:

JUNEAU, Alaska (AP) — About 7,700 people have enrolled in Medicaid since the state expanded the program on Sept. 1 to cover more lower-income Alaskans, a state health department official said.

The agency appears on track with projections that a total of about 20,100 newly eligible people would enroll in Medicaid during the first year of expansion, Chris Ashenbrenner, Medicaid program coordinator for the health department, said Tuesday.

A study commissioned by the department estimated that about 42,000 people would be eligible for Medicaid under expansion but only about 20,100 would enroll the first year.